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Background: Half of the world's children experience violence every year, but the meaning of violence is not universally agreed. We may therefore risk failing to measure, and address, the acts that matter most to children and adolescents. In this paper, we describe and synthesise evidence on how children and adolescents in sub-Saharan Africa conceptualise different behavioural acts which are deemed violence in childhood under WHO and UN CRC definitions. Methods and findings: We conducted a systematic review of qualitative studies. We searched PsychINFO, CINAHL, Embase, Global Health, Medline and ERIC for all publications released prior to March 2023. 30 papers met inclusion criteria. We synthesised primary data from children and adolescents and drew upon theoretical and contextual interpretations of authors of included studies. Only 12 of more than 45 sub-Saharan African countries were represented with relevant research. Of the 30 included papers, 25 came from three countries: South Africa, Uganda and Ghana. Only 10 of 30 papers reported data from young children (pre-adolescence), and 18 of 30 papers primarily focused on sexual violence. 14 studies used child friendly and/or participatory methods. From this limited evidence, we identified six overarching themes in how children and adolescents conceptualised their experiences of acts internationally recognised as violence: 1) adults abusing or neglecting responsibility; 2) sexual violence from peers, family and community members; 3) violence in established intimate relationships; 4) emotional violence surrounding sex from peers and community members; 5) fighting and beating between peers; 6) street and community dangers. No studies meeting our inclusion criteria specifically examined children or adolescents' conceptualisations of homophobic or transphobic violence; violence against children with disabilities; boys' experiences of sexual violence from male perpetrators; trafficking, modern slavery or conflict; child labour; or female genital mutilation. We found that three dimensions were important in how children and adolescents constructed conceptualisations of violence: their age, relationship to the perpetrator, and the physical location of acts they had experienced. These dimensions were interrelated and gendered. Conclusion: The current limited evidence base suggests children and adolescents' conceptualisations of violence overlapped with, but were also distinct from, the WHO and UNCRC definitions of violence. Currently international survey tools focus on measuring types and frequencies of particular acts and neglect to focus on children's understandings of those acts. Relationship to perpetrator, age of child, physical location are all important in how children conceptualise their experiences of acts internationally recognised as violence, and therefore might be important for their health and social outcomes. Those developing measures should account for these dimensions when developing items for testing. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM. [ABSTRACT FROM AUTHOR]

Background: Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. Methods: Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003–2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. Results: A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). Conclusion: Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM. [ABSTRACT FROM AUTHOR]

Female genital cutting (FGC) is a widely blamed practice for violating women’s reproductive rights and health. However, the diversity and complexity of FGC-related beliefs and practices within the same cultural setting have never been adequately explored. This paper aims at examining this issue in the context of Gamo cultural procedure relying on ethnographic data gathered from selected communities. The findings revealed that the Gamo cultural setting exhibits a considerable internal diversity related to the meanings and practices of FGC. Taboos prohibiting and cherishing FGC are pervasive across Gamo communities that share the same general culture. FGC is regarded as a polluting practice in some communities and as a purifying process in others. In this diverse and complex cultural landscape, girls/women are protected from FGC in some communities, while they are forced to undergo FGC in other communities in different local contexts. The paper concludes that blaming African cultures for exposing women to FGC and for violating their physical integrity could be a crude generalization of a complex phenomenon because in some circumstances, FGC-related discourses and practices are contested within the same cultural setting; and in some African cultures, the notion of women's physical integrity is highly valued. [ABSTRACT FROM AUTHOR]

Introduction: The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. Methods: This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. Results: The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. Conclusion: Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices. [ABSTRACT FROM AUTHOR]

DESPITE GLOBAL CONCERN about the harmful effects of female genital mutilation (FGM), some still believe that it is a tradition that must be upheld. Male involvement in the practice has been debated over the years. This paper has two objectives: first, to present the views of men about their intention to circumcise their daughters in the future; and second, to identify factors associated with their intention to do this. To investigate this, the study analyzed cross-sectional data on FGM collected in the Kassena-Nankana District of northern Ghana in 1998. The study found that 14 percent of male respondents expressed their interest in circumcising their daughters in the future. Regression analysis showed that the odds of intending to circumcise one's daughter in the future were higher among those practicing traditional religion and the less educated, than among those professing Christianity and the highly educated The results call for intensification of efforts to eradicate the practice of FGM particularly in settings where every critical event in the life cycle of individuals is accompanied by rites involving soothsayer (ancestral) consultation. [ABSTRACT FROM AUTHOR]

Background: Globally, an estimated two million women have undergone Female Genital Mutilation (FGM), and approximately four percent of women who have been circumcised live in Ghana. In the Bawku Municipality and Pusiga District, sixty one percent of women have undergone the procedure. This study therefore aimed at identifying the factors that sustain the practice of FGM despite its illegality, in the Bawku Municipality and the Pusiga District. Method: This study used a descriptive qualitative design based on grounded theory. We used purposive sampling to identify and recruit community stakeholders, and then used the snowball sampling to identify, recruit, and interview circumcised women. We then used community stakeholders to identify two types of focus group participants: men and women of reproductive age and older men and women from the community. In-depth interviews and focus group discussions were conducted and qualitative analysis undertaken to develop a conceptual framework for understanding both the roots and the drivers of FGM. Results: Historical traditions and religious rites preserve FGM and ensure its continuity, and older women and peers are a source of support for the practice through the pressure they exert. The easy movement of women across borders (to where FGM is still practice) helps to perpetuate the practice, as does the belief that FGM will preserve virginity and reduce promiscuity. In addition, male dominance and lack of female autonomy ensures continuation of the practice. Conclusion: Female Genital Mutilation continues to persist despite its illegality because of social pressure on women/girls to conform to social norms, peer acceptance, fear of criticism and religious reasons. Implementing interventions targeting border towns, religious leaders and their followers, older men and women and younger men and women will help eradicate the practice. [ABSTRACT FROM AUTHOR]

This study investigates the paradoxical situation of the relatively high number of Ghanaian nationals applying for asylum in various countries, whereas Ghana is widely recognised as having a positive record on the protection of human rights. This study analyses the requests for asylum submitted by 30 Ghanaian nationals (10 women and 20 men: generally men outnumber women in asylum applications) to seven countries (Australia, Canada, France, Ireland, New Zealand, the UK and the US) over the last 25 years. [ABSTRACT FROM AUTHOR]

ABSTRACT Female genital cutting is waning in northeastern Ghana, even though NGO and state discourses suggest otherwise. Women who no longer perform the practice do not, as anthropologists often posit, resist anticutting advocacy. Rather, they critique what NGO and state interventions leave unaddressed. These women understand the ending of cutting as an index of food scarcity and governance that saps their blood and vitality. Cutting had to stop, they say, because they could no longer afford to lose more blood. Drawing on indigenous and biomedical understandings of health and popular notions of occult economies, they critique the contemporary governance that simultaneously invests in their lives and causes bodily attrition. 'Slow harm' reveals how the invisible violence of neoliberal democracy produces ordinary crises and makes bodies vulnerable. [ABSTRACT FROM AUTHOR]

Background: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM). Methods: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage. Results: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0. 4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95% CI 0. 02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy. Conclusions: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed. Keywords: Female genital mutilation, Episiotomy, FGM, Circumcision, Obstetrics [ABSTRACT FROM AUTHOR]

Mass media play an important role in explaining the issue of female genital cutting and can influence discourse among the general public as well as policy makers. Understanding how news media present female genital cutting has strong implications for the global status of women. This study, a quantitative content analysis, analyzed how 15 years of newspaper coverage surrounding the launch of the Millennium Development Goals framed female genital cutting in four countries with varying prevalence levels of female genital cutting: the United States, Ghana, The Gambia, and Kenya. The study found female genital cutting is consistently portrayed as a problematic and thematic topic, largely tied to cultural rituals. However, coverage is minimal and inconsistent over time, and does not appear to be impacted by the increase in international initiatives aimed at combatting the practice. [ABSTRACT FROM PUBLISHER]

This article asks what anthropology can contribute to public and scholarly debates about politics of knowledge in global governance and argues that bringing together insights from aesthetics of governance, science and technology studies, and theories of performativity offers a productive reorientation to existing approaches. My specific question is: how did WHO research that was intended to counter alarmist discourses about female genital cutting end up legitimizing them? For anthropologists who participated in the scientific controversy, the answer was clear: the study was driven by ideology. To expand the range of analytical responses, I suggest, we need to understand the rearrangements of knowledge and power in neoliberal governance, as well as a conception of authorship that uncouples scientific statements from sovereign subjects. Deadly harms were not made certain by ideology, I argue, but by aesthetics of expertise, WHO bundling of governance by emergency and governance by evidence, and performative iterations at the cultural boundaries of science. To make this argument, I analyze the historical conditions of possibility for the WHO study, offer an ethnography of knowledge production, and trace the social and governmental lives of fact and meaning-making. [WHO, female genital cutting, science controversy, governance by evidence, anthropology in the public sphere, aesthetics, performativity] [ABSTRACT FROM AUTHOR]

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Although many cross-sectional social surveys have included questions about female genital cutting status and correlated personal characteristics, no longitudinal studies have been launched that permit investigation of response biases associated with such surveys. This study draws upon the findings of a longitudinal study of women aged 15 to 49 in rural northern Ghana. The self-reported circumcision status of women interviewed in 1995 was compared with the status they reported when they were interviewed again in 2000 after the government began enforcing a law banning the practice and public information campaigns against it were launched. In all, 13 percent of respondents who reported in 1995 that they had been circumcised stated that they had not been circumcised in the 2000 reinterview; this inconsistency reached 50 percent for the youngest age group. Analysis shows that women who said they had not been circumcised are significantly younger, more likely to be educated, and less likely to practice traditional religion than are women who reported that they were circumcised. Factors that may explain these correlates of denial are discussed, and implications for research are reviewed. [ABSTRACT FROM AUTHOR]